Hallux Valgus (Bunion)

1. About the Diagnosis

Hallux valgus is a progressive deformity of the first metatarsophalangeal (MTP) joint, characterized by lateral deviation of the great toe (hallux) and medial prominence of the first metatarsal head (“bunion”). Over time, soft‐tissue imbalance and altered joint mechanics lead to further angulation, pain, and joint degeneration.

2. Signs & Symptoms / Clinical Presentation

  • Visible Deformity: Medial “bump” at the first MTP joint; the great toe drifts toward the second toe.

  • Pain & Tenderness: At the bunion site, especially in tight or narrow shoes.

  • Callus or Bursitis: Thickened skin or inflamed bursa over the prominence.

  • Limited Range of Motion: Stiffness or crepitus of the first MTP joint.

  • Secondary Toe Issues: Overlapping toes, hammer‐toes, interdigital corns.

  • Gait Alterations: Patients may shift weight laterally to avoid pain, leading to metatarsalgia.

3. Diagnostic Tests

  1. Clinical Examination:

    • Measure the hallux valgus angle (HVA) by sight and goniometer: > 15° is abnormal.

    • Assess first MTP joint mobility and the presence of reducibility.

  2. Weight‐Bearing X-Rays (AP & Lateral):

    • HVA: Angle between the long axes of the first metatarsal and proximal phalanx.

    • Intermetatarsal Angle (IMA): Angle between first and second metatarsals (> 9° indicates severity).

    • Evaluate joint congruity, sesamoid position, and any arthritic changes.

  3. Footwear Assessment & Biomechanical Evaluation:

    • Observe shoe wear patterns and pronation/supination during gait.

4. Treatment Plan

Approach* Description* Conservative*

*Footwear Modification:
– Shoes with a wide, deep toe box (e.g., New Balance 990, Brooks Ghost).
– Rocker‐sole or stiff‐soled shoes to reduce MTP joint motion.

• Padding & Splinting:
– Bunion cushions (e.g., Dr. Scholl’s® Bunion Pads) to off‐load pressure.
– Silicone toe spacers or gel bunion correctors to realign the hallux during non–weight‐bearing.
– Night splints (e.g., Pedifix® Bunion Night Splint) to gently stretch the medial capsule.

• Orthotic Devices:
– Prefabricated or custom medial‐arch support insoles (e.g., Superfeet® Green) to improve biomechanics and reduce pronation.

• Physical Therapy:
– First MTP joint mobilization and toe‐spreading exercises.
– Calf and intrinsic foot muscle strengthening.

• Pharmacotherapy (Symptomatic):
– NSAIDs (Ibuprofen 200–400 mg every 6–8 h, Naproxen 250–500 mg BID) to reduce pain/inflammation.
– Topical NSAID gel (e.g., Voltaren®) applied over the bunion 2–3 times daily.

Surgical*

Indicated for persistent pain, deformity progression, or failed conservative care.
• Chevron (Austin) Osteotomy: Distal metatarsal “V”‐shaped cut and lateral translation—ideal for mild‐to‐moderate deformities.
• Scarf Osteotomy: Diaphyseal Z‐shaped cut offering greater correction for moderate deformities.
• Lapidus Arthrodesis: First TMT joint fusion for severe deformity with metatarsus primus varus or hypermobility.
• Proximal Chevron or Opening‐Wedge Osteotomy: For large IMAs.

• Postoperative Care:
– Analgesia: Acetaminophen 650 mg PRN, plus NSAIDs unless contraindicated.
– Antibiotic Prophylaxis: Cephalexin 500 mg pre-op and for 24 h post-op.
– DVT Prophylaxis: Enoxaparin 40 mg daily if high risk.
– Specialized Footwear: Postop shoe or boot for 4–6 weeks.
– Physical Therapy: Gradual ROM and strengthening starting 4–6 weeks post-op.

Products & Medications to Consider

Dr. Scholl’s® Bunion Pads

Pedifix® Bunion Night Splint

Superfeet® Green Insoles

New Balance 990 (wide‐toe box athletic shoe)

Ibuprofen 200–400 mg (OTC)

Voltaren® Gel (diclofenac topical)

Custom Orthotics (if flat foot or hyperpronation is significant)

Next Steps:
Begin with conservative measures for at least 3–6 months. If pain or functional limitation persists—or radiographs reveal severe angular deformity—refer for surgical evaluation. Early intervention improves long-term outcomes and patient satisfaction.

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The content provided on this site is for educational purposes only and is not intended to replace the advice of a qualified medical professional. Always seek the guidance of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.*